Provider Demographics
NPI:1265672844
Name:STATE-BOUND TREATMENT SERVICES LLC.
Entity type:Organization
Organization Name:STATE-BOUND TREATMENT SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMDIRECTOR/LEAD CLINICAL STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRAVAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MASTER OF S
Authorized Official - Phone:864-906-1043
Mailing Address - Street 1:112 SUGAR CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-906-1043
Mailing Address - Fax:
Practice Address - Street 1:112 SUGAR CREEK ROAD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-906-1043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty